|Vaginismus is a sexual pain disorder, indicating persistent or recurrent difficulty in allowing vaginal entry of the penis, finger, or any object, despite the womanâs expressed wish to do so. It is a condition in which the muscles in the vagina spasm involuntarily preventing vaginal penetration or, if penetration is possible, it can be painful. The cause of vaginismus is unknown however fear, anxiety, and pain are three contributing factors. Botulinum toxin A is a neurotoxin produced by Clostridium Botulinum that paralyzes muscles by the prevention of acetylcholine release and has been shown to be useful in treating conditions associated with neuromuscular dysfunction such as muscle hyperactivity. This toxin has a long-duration action of up to 6 months. During this time period, patients have ample time for progressive dilation and most patients have successful intercourse within 1-2 months, some within a matter of days. The vaginal injection of Botox is usually a one-time outpatient procedure. Although Botox loses its effectiveness within 4-6 months, a second Botox procedure is usually not needed if the patient has made the transition from post-operative dilation to intercourse during this time period.